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Nonalcoholic fatty liver disease (NAFLD) is the most prevalent form of chronic liver disease in the world. It has been estimated that as many as 30% of adults in both Western countries and Japan have NAFLD. The clinicopathologic spectrum of NAFLD extends from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). While NASH carries a high risk of liver disease-related mortality, such as death from hepatic cirrhosis and hepatocellular carcinoma, NAFL carries a low risk of liver disease-related mortality. Therefore, it is clinically important to distinguish NASH from NAFL. While numerous non-invasive tests for differentiating NASH from NAFL have been developed, the NAFIC scoring system, based on the serum level of ferritin, fasting serum level of insulin and serum level of type IV collagen 7S, has been recognized as a simple and reasonably accurate and clinically useful tool for predicting the presence of NASH in Japanese patients with NAFLD. Furthermore, a modified NAFIC scoring system has also been developed, modified by changing the weightage assigned to the fasting serum insulin level based on the importance of hyperinsulinemia in the pathogenesis of NASH. We investigated the clinical usefulness of the modified NAFIC scoring system, and showed superior sensitivity of this modified scoring system for the diagnosis of NASH.
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